Advances in Hematologic Malignancies Issue 9, Fall 2018
Each year, thousands of people learn – often after a routine blood test – that they have a precursor condition that may develop into a blood cancer such as leukemia, myelodysplastic syndrome, or multiple myeloma. Three years ago, Dana-Farber Cancer Institute launched PCROWD, an online crowd-sourcing initiative to collect clinical data from patients diagnosed with these conditions, with the goal of identifying predictors of progression to cancer.
Against the backdrop of PCROWD and much other research by Dana-Farber faculty investigators on precursor conditions, Dana-Farber has taken the next step: opening a multi-disciplinary clinic, the first of its kind, to provide patients with these precursor conditions a roadmap for clinical care and monitoring, while aiding scientists in developing targeted therapies that could halt the progression of precursor conditions before they cause systemic disease or organ damage.
The Center for the Prevention of Progression (CPOP) will enable patients to be seen by physicians who specialize in these conditions, and – as needed – will arrange consultation with cardiologists, psychologists, social workers, genetic counselors, and other practitioners to help manage their conditions over time.
CPOP will provide guidelines for managing the care of patients with precursor conditions, primarily clonal hematopoiesis of indeterminate potential (CHIP); monoclonal gammopathy of undetermined significance (MGUS); lower-risk myelodysplastic syndromes (MDS), and smoldering multiple myeloma (SMM). The clinic will also be a resource for healthy individuals who are at high risk because they are close family members of patients with blood cancers. In addition to those with inherited or germline predispositions, some groups are at particularly high risk: people 70 years and older are at increased risk for CHIP, for example, while MGUS is 3 times more common in African-Americans.
The emphasis will be on early detection of progression from the precursor state to a malignant state, and on research aimed at developing biomarkers to identify patients who are more likely to progress and develop a further malignancy. In addition, researchers plan clinical trials to evaluate methods of intercepting precursor conditions before they lead to overt cancer or other complications.
"The new clinic is a patient-centered initiative that will harness the breadth and depth of services at Dana-Farber to provide support for individuals with precursor conditions, and to expand treatment options for individuals with these conditions," says Robert Soiffer, MD, chief of the Division of Hematologic Malignancies.
Irene Ghobrial, MD, who specializes in research on precursor hematological malignancies, specifically MGUS and smoldering myeloma, is creator of the clinic.
Clinic leader David Steensma, MD, emphasizes the acute need for this clinic: "People with precursor conditions are a population that is growing and will continue to grow as the population ages and as more patients survive therapy for solid tumors. I feel that we must be careful to avoid over-medicalizing these precursor conditions and increasing patients' anxiety.
"At the same time, it is clear that CHIP predisposes to cardiovascular death as well as to MDS and leukemia, while MGUS predisposes not only to myeloma but to a variety of renal, dermatological, and immunological conditions, so these are real problems. There are now tools that may prevent complications that deserve testing."
Steensma adds, "Furthermore, as genetic testing expands for patients with solid tumors – especially with sensitive methods for metastatic disease, such as assays for cell-free tumor DNA – frequently, mutations such as JAK2 are discovered that are not in the solid tumor but are in the blood cells. Our colleagues across the Institute and our collaborative sites need a place to refer these patients."